Not bothered that your doctor's education comes from pharma? Have a look, then, at the "communications" arm of this lucrative business. Here the results are scientific articles, often in peer-reviewed medical journals. The money is laundered in much the same way. Pharma pays the MECC; the MECC puts together the articles; academic physicians are paid to sign onto the articles, and the MECC places the articles in medical journals. Some academics simply sign ghostwritten articles, while others work from a draft supplied by the company. Sticklers for honesty merely take the money and write the articles themselves. Fees vary. Some academics have signed on for as little as $1,000 or $1,500 per article, including the two faculty members at the Medical University of South Carolina who recently "authored" a ghostwritten article on Ritalin for Novartis.5 Others command much higher fees. When the debate over second-hand smoke was heating up in the early 1990s, the tobacco industry paid a biostatistician $10,000 to write a single letter to the Journal of 'the American Medical Association.6 Warner Lambert, the maker of Neurontin, a seizure drug, gave a professor at the University of Minnesota over $300,000 to write a textbook on epilepsy.7

None of this is exactly new. What is new is the magnitude of the phenomenon, which has only become evident through recent litigation. For years, nobody really knew how much of the medical literature was ghostwritten, or even how much had originated from pharma. (Ghosts take care to remain invisible.) The most widely cited article on ghostwriting, published in JAMA in 1998, found evidence of ghostwriting in 11 percent of articles published in six major American medical journals.8 To the uninitiated that figure may sound alarmingly high. But according to a recent study by David Healy and Dinah Cattell in the British Journal of Psychiatry, it may actually be unrealistically low.9

Thanks to Anne Taylor-Vaisey for sharing this one with me, and now you. I just wrapped up an article for the July/August issue of Medical Meetings about all this, and its impact on CME--one of the more interesting articles I've had the pleasure of researching, even if it did leave me feeling slightly nauseated.